Childhood Obesity: The Role of Health Policy - Association of ...

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The report by Nestle & Jacobson identified seven domains for policy action (see Exhibit 3 and health care was included. Four health care recommendations were noted; two calling for health professional training approaches, one calling for the development and funding of a research agenda on the causes of, and treatments for, obesity, and one to revise Medicaid and Medicare to provide incentives for providerbased nutrition and obesity counseling and other related services. The second review was conducted under the auspices of the Partners in Program Planning for Adolescent Health (PIPPAH) initiative partners and published in 2004. 7 This review summarized the existing policies of 10 organizations who are members of the National Coalition on Adolescent Health or PIPPAH partners (see Exhibit 4). Policies covering both healthcare aspects (e.g., reimbursement for treatment and screening, evaluation and treatment), as well as broader issues (e.g., food labeling and school nutrition), were mentioned by one or more of these organizations. The most common domain included in these organizations’ statements was physical activity and sports; 49 recommendations were identified, of which 16 were targeted at clinical interventions with individual patients and 33 were focused on the scope, content and nature of physical activity programs, often within the school setting (see Exhibit 5). Only two organizations had a position on reimbursement for treatment of obesity. A content analysis 8 of those recommendations revealed that the recommendations revealed that they focused about equally on clinician actions at the individual patient level (92 recommendations) versus calling for broader policy actions on the part of clinicians, schools, or other stakeholders (111 recommendations). However, nearly 70% of these broad policy recommendations statements focused exclusively on the school’s role in nutrition, food labeling or advertising, or physical activity. These two types of recommendations were often woven together in linked statements, e.g., “Pediatric dentists should provide dietary counseling in conjunction with other preventive services for their patients. School health education programs and food services should promote balanced, low caries-risk diets.” In our own review of the policies or initiatives of 30 organizations, we found that only 14 had a formal position or policy on childhood obesity (see Appendix B for complete list of organizations). Many more had programs or initiatives or were in the process of developing a statement. For those organizations with a formal policy/statement, several common themes related to health care emerged: Exhibit 5: Domain & Target of Policy Recommendations Included in Statements Domain Organizations (N) Recommendations (N) Target Patient Policy Diet & Nutrition: general 7 27 19 8 Education & Training 6 29 15 14 School Nutrition 6 27 1 26 Physical Activity & Sports 5 49 16 33 General Statements 4 11 2 9 Special Populations 4 14 12 2 Screening, Evaluation & Treatment 3 26 25 1 Food labeling & Advertising 3 14 1 13 Health insurance & reimbursement for treatment 2 4 – 4 Total 7 201 92 111 11
Individually-Focused Themes: • More engagement of health care providers/clinicians in the prevention, diagnosis and treatment of childhood overweight (10 of 30 organizations; AAP, Society of Pediatric Nurses (SPN), IOM, AMA, IOM, AMA, America’s Health Insurance Plans (AHIP), Association of State and Territorial Health Officers (ASTHO), National Academy for State Health Policy (NASHP), National Association of School Nurses (NASN), North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), North American Association for the Study of Obesity (NAASO)). • Regular BMI measurement and weight management of children, with monitoring and accessible counseling/interventions to lower it, if necessary. Measurements should be performed by trained health workers. (13 of 30; AAP, IOM, (American Dental Association ADA), AMA, AHIP, ASTHO, NASBHC, NIHCM, NASHP, National Association of County and City Health Officials (NACCHO), NASN, NASPGHAN, NAASO) • Identification and management of risk factors such as genetics, obesity-related chronic disease, ethnic disparities, poverty and other socioeconomic factors in under-privileged communities (eight of 30; AAP, Society of Pediatric Nurses (SPN), ASTHO, NIHCM, NACCHO, NASN, NASPGHAN, and NAASO). • Early start of prevention of overweight is essential (six of 30; AAP, NIHCM, NACCHO, National Association of Pediatric Nurse Practitioners (NAPNAP), NASN, NASPGHAN). Broader Policy Themes: • Inclusion of physical activity and healthy nutrition in curricula of educational institutions of health care professionals and schools (12 of 30; AAP, Centers for Disease Control Task Force on Community Preventive Prevention Services, IOM, ADA, AMA, AHIP, ASTHO, NIHCM, NASHP, NACCHO, NAPNAP, NAASO) • Association of low physical activity and poor nutrition with overweight/obesity should be addressed (and managed through counseling and referrals) in schools and to parents or caregivers in the community (13 of 30; National Assembly on School-Based Health Care (NASBHC), AAP, ADA, AMA, AHIP, ASTHO, NIHCM, NASHP, NACCHO, NAPNAP, NASN, NASPGHAN, NAASO) • Reinstatement of (mandatory) quality physical education by the government for kindergarten through 12th grade at the minimum (three, at least (2 of 30; AAP, ADA)) • Coverage of obesity prevention and treatment by health care insurers and providers (9 of 30; AAFP, AAP, IOM, NIHCM, AMA, AHIP, ASTHO, NASHP, NAASO) Making funding available through collaborative efforts to promote healthy life-styles, and for research to combat overweight (10 of 30; SPN, IOM, NIHCM, AMA, AHIP, ASTHO, NASHP, NACCHO, NASN, NAASO). A final aspect of health care organizations’ role, and indeed individual health professionals’ role, that has not been well examined is that of role model. 9 Individually, as a profession, or as employers, physicians, other health professionals, and leaders in health care organizations can embody a message of 7 PIPPAH is a project organized by the American Medical Association and funded by the Maternal and Child Health Bureau in 1996. 8 Any statement that called for a specific and discrete action counted as a discrete recommendation (e.g.., should provide education). Additional statements that described the action in more detail did not contribute to the totals (e.g.., the education should include…). 9 This section is in large part adapted from a presentation by Dr. Brian McCrindle at the December 2007 AHA Obesity Research Summit. 12
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